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M. Shimakawa, Y. Kawahara, M. Toyoguchi, Y. Ohashi, H. Matsuo, S. Hori; Comparing the Clinical Features of Anterior Uveitis Between Patients With HLA–B27 Associated Acute Anterior Uveitis or Behcet’S Disease . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2424.
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© ARVO (1962-2015); The Authors (2016-present)
Non–granulomatous anterior uveitis, sometimes with hypopyon, is commonly seen in the patients with HLA–B27 associated acute anterior uveitis (AAU) or with Behcet’s disease (BD). Although in BD, the inflammation distinguishingly expands into the posterior segment, the clinical features between these two diseases are still unclear. The purpose of this study is to clarify the different features of anterior uveitis between these two diseases.
We conducted a prospective study and compared 20 eyes of 16 patients with HLA–B27 associated AAU ( HLA–B27 Group) and 79 eyes of 43 patients with BD ( BD group) who satisfied the criteria by the International Study Group for Behcet’s disease. All patients had frequent recurrences of acute inflammation. The patients were followed up from April 2003 to October 2005. The total number of relapses was 44 times in the HLA–B27 Group and 174 times in the BD Group. For treatment of anterior uveitis, every patient in this study was treated by topical steroids and by mydriatica only. Peribulbar injection of steroids was performed to patients with refractory inflammation, such as hypopyon.
The duration of inflammation nadir was defined as the average days of inflammation from the first recurrence signs of acute uveitis to the peak of inflammation. Continual inflammation was the total days of inflammation detected. The frequencies of posterior synechia or hypopyon were investigated and were compared between the two groups. Statistical analysis was done by Chi–squared or Mann–Whitney test.
The average days to reach inflammation nadir was significantly longer in the HLA–B27 Group than in the BD group (8.3±4.0 days in HLA–B27 Group vs 2.2±1.6 days in BD group, P<0.0001). The continual inflammation was significantly longer in the HLA–B27 Group than that the BD group (25.8±7.7 days in HLA–B27 Group vs 18.0±8.4 days in BD Group, p<0.005). The frequency of posterior synechia was 40.9% (18/44 times) of the total recurrences in the HLA–B27 Group and 1.7% (3/174 times) in the BD Group. The extent of posterior synechia angled 216±31 degree in the HLA–B27 Group and 54±20 degree in the BD group. The complication of posterior synechia was not only frequent but also extensive in the HLA–B27 Group compared with the BD group (p<0.001). The frequency of hypopyon in the HLA–B27 Group (27.3%, 13/44 times) was significantly higher than in the BD Group (5.2%, 9/174 times).
HLA–B27 associated AAU has more distinguishing and severe clinical features when compared with anterior uveitis in BD.
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